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Immobilization
Slings
| The standard triangular bandage (available in any drugstore and costing
about $1) is compact and light, and can fit in virtually any portable first aid kit. The
package is about 2x3 inches, and 3/8" thick. It has other uses besides a simple
sling: tying on dressings and splints, for example. |
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Create a sling by folding the middle of the long edge under the arm, with
the 90° corner of the triangle at the elbow. Pull the long ends up and around the neck.
It's most comfortable if the inner side of the sling goes around the neck on the hand
side, while the outer side goes around on the elbow side. Tie the sling with a square know
behind the neck, so the wrist tips slightly upward in relation to the elbow. Pull the
extra cloth out from the elbow and tie a simple overhand knot in it. This keeps the arm in
place within the cradle of the sling.
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| To give extra protection to the shoulder for upper arm fractures,
collarbone or AC joint separations, add a binder to the sling. This can be a second sling
wrapped around chest over top of the first sling, a shirt placed over the sling (putting
only the "good" arm through the sleave), or an ace wrap around the chest as
shown at right. For temporary immobilization of a dislocated shoulder, place the sling,
then wad up a biking shirt and put it between the elbow/forearm and the chest. (In a
dislocation, the elbow is usually slightly out sideways, about 6 inches away from the
body.) Now place a binding wrap. If it hurts to bind the arm, add more padding between
elbow and chest. |
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If you're treating the injury at home, you may want to
upgrade your sling once you're back at civilization. Buy a standard sling at your local
medical supply store. Slings are available with one strap (as shown), two straps, and with
a binding strap. Select one that will keep you comfortable during your required
activities. |
| The triangular bandage sling has a lot of other uses: Securing a head
wound compression dressing (as at right).
Bulk for compression of hemorrhage.
Binding a compression pack for severe extremity hemorrhage (beware of a tournequet
effect).
Providing padding and bulk for a dressing.
Tying temporary splints to an extremity (see below). |
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Splints
When splinting a painful injury, it's best to "splint it where it lies." In
other words, place the splint so the extremity stays in the position you found it in. It's
best not to try to straighten out a deformity, unless it's necessary to get the victim out
of the wilderness.
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An excellent splint is made by wrapping a pillow around the injured arm or
leg, then binding it tight with tape around the pillow. Or, roll a magazine around an arm
as a temporary "cast." Tie the magazine with a triangular bandage (sling), tape,
or a bike inner tube. After placing the splint, watch the color of the skin downstream.
If the skin becomes pale or dusky, loosen the straps that bind the splint.
You can tell that a splint is effective if other people can move you without creating
severe pain in the injury. |
| If you're treating a wrist sprain at home (be careful about this --
painful "sprains" are often subtle wrist fractures), you can purchase a splint
at your local medical supply store. While a pull-on elastic tube splint can give some
support, it's not enough to allow you to lift. Consider a splint with metal strips top and
bottom. |
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For finger injuries, I recommend a foam-backed aluminum splint. The splint
is placed on the underside of the finger. You can cut the splint to length with EMT snips
and bend it to the most comfortable position. Bind it with a couple of strips of tape.
Stretchy cloth tape, while more expensive and harder to find than non-stretch tape) is far
superior for holding a splint. |
| EMT snips are handy for your car first aid kit. You'd be surprised how
often they come in handy for non-first-aid purposes. They'll cut an aluminum split to side
readily, and can be used to custom-fit gauze pads for efficient dressings. |
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Popsicle sticks and most drugstore off-the-shelf splints have one big
problem: they force your finger straight. This is painful for most finger sprains -- it
stretches the injured ligaments and may actually interfere with healing. Plus, a straight
finger gets in the way more. Usually it's best to splint the finger in the
most comfortable position, which is with all joints slightly bent. |
| Specialty splints such as ankle and knee braces can be purchased without
prescription at a medical supply store. But you need to know what you're treating, and how
to adjust and use the splint properly. If an injury seems bad enough to cough up $60 for a
special splint, you should probably go to the ER and have it checked. |
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Wraps
There are three ways you can provide a wrap: (1) a standard compression wrap ("Ace
wrap"), which is heavy and thick but provides a fair amount of stability and
"squeeze," (2) self-adhering (Coban) wrap, which is thin and light, and (3)
compression sleeves, which are pre-fab pull-on wraps for knee, elbow, and wrist that you
can buy at the drugstore.
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The compression (Ace) wrap is the standard wrap for orthopedic injuries.
It provides a fair amount of padding, modest immobilization, and compression. You can
increase the stiffness of the immobilization and the pressure of compression by
wrapping
tighter. Cold-packs can be placed over the wrap. When wrapping an ankle, use a
figure-eight or two (see below) for stability. A 4-inch ace works best for the ankle. |
An altered "extra loop" figure-eight provides stability. When wrapping the
ankle or elbow, position the joint as close to 90 degrees as possible. Make two or three
circular passes below the joint, moving the wrap towards the joint. Once the wrap reaches
the joint crease, cross directly in front of it, then wrap around the back above the
joint. Wrap around once above the joint (the "extra loop"), then cross back down
in front of the joint to complete the figure-eight.
| Self-adhering wrap (sample brand Coban) is light and thin. While I use it
mostly to secure dressings, it can also provide immobilization and compression of an
orthopedic injury. Use it just as you would an Ace wrap, with one precaution: because
the wrap sticks to itself as you unroll it, you can easily make the wrap too tight. Pull a
length off the roll first, then adjust the tension before applying it to the joint. |
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When applying an ace to the wrist, come up onto the hand, passing the wrap
between the thumb and index finger. A two-inch wrap works best for the wrist. |
| A compression wrap can be used to immobilize broken ribs. A 4-inch ace is
the size you're most likely to have available, and it will usually work, but a 6-inch is
ideal. Have the victim blow their air out and hold the arms up. Wrap around snugly. The
wrap should be just tight enough to ease the sharp pain with breathing, but not tight
enough to make breathing difficult. |
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